Provider Demographics
NPI:1598245573
Name:AINSLIE, LEANN DEBOER (OT)
Entity Type:Individual
Prefix:
First Name:LEANN
Middle Name:DEBOER
Last Name:AINSLIE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 BRILEY ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-4015
Mailing Address - Country:US
Mailing Address - Phone:901-301-0402
Mailing Address - Fax:
Practice Address - Street 1:2505 S 37TH ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-7103
Practice Address - Country:US
Practice Address - Phone:254-298-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-18
Last Update Date:2018-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111573225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist